If there were no CNAs...would that be a bad thing?

[Kunzieo]

Hi. I almost hate to start another CNA thread, as so many degenerate into a nurse-vs.-cna thing....but that is not my purpose here.

We were talking in class today about how the trend in the hospitals (here in the Twin Cities, anyhow) seems to be working toward eliminating the CNA (PCA, aide, whatever.)

I work as a PCA on a cardiac step-down unit that recently re-worked their staffing grid. They lowered the patient ratios for the RN's (3-4pts) and greatly increased the patient ratios for the PCAs (~10pts on days/eves, and ~18 pts on nights.)

Many of the PCAs I work with (and some PCAs in my class) are angry about this. (Having to work harder...not feeling as valued.)

I actually think it makes a lot of sense. I think if you could get acceptable patient ratios, nurses might be better off doing all the cares for the patient themself. And I mean ratios that NURSES find acceptable, not management.

Then nurses would have the opportunity to examine/assess the patient during bath/changing/etc. Never again would the nurse have to worry if the vitals are accurate, or if the CNA measured urine correctly, or if the blood sugars will be done in time for insulin before breakfast. This appeals to me because I always prefer to do my own work....I always worry that it wasn't done "right" or well enough when I have to work with partners.

So...my question is...

Does this appeal to you at all? Why or why not? What kind of unit do you work on and what would your patient ratio (or accuity level) have to be in order for this to work for you?

Thanks!:redpinkhe

[EmmaG, RN]

A good tech is worth their weight in gold and a valuable part of the team. They often make the difference between simply a hectic, busy shift and The Shift From Hell.

P.S. They can have my tech when they pry them from my cold dead fingers.

Or something like that...

[BlueRidgeHomeRN]

on postpartum (several years ago) we had an all rn staff-no aides,, no lpn's. this harkens back to a nursing theory of "primary care nursing" from a while back. the rn does all care. it's great for the patient, and we loved knowing what was going on with our patients, but it isn't cheap.

don't know where you live, but here there are more and more aides and techs in all levels of inpatient care, and fewer and fewer rn's..

gue$$ why?

[Virgo_RN, BSN, RN]

CNAs are a valuable part of the care team. I couldn't do my job without them.

[Ivanna_Nurse, BSN, RN]

I work in an 8 bed general ICU. It is RN staffed, with 1 nurse per 2 pts max. We work 12's and I like the continuity of care that gives...I generally find myself giving report to the same person that I had gotten report from earlier. The pts only have to keep track of the day nurse and the nite nurse. We generally have no CNA, but do have a unit secretary who does orders, watches the tele's on the floor and takes care of the paper work parts. We are a primary care floor, and that is pt assessment all the way to refilling paper towel dispensers and emptying garbages. On the really bad days when we get an extra CNA from the Med Surg floor, when we are full or have high acuity pts, like suicides or vents. I feel out of control when they are there, like I have less of a grasp on whats going on, and like previously mentioned, I like knowing that things are done the right way and at the right times. Probably not the answer that you will get from everyone that posts, but I like being at the bedside as much as I am. ~Ivanna

[Spidey's mom, ADN, BSN, RN]

A good tech is worth their weight in gold and a valuable part of the team. They often make the difference between simply a hectic, busy shift and The Shift From Hell.

P.S. They can have my tech when they pry them from my cold dead fingers.

Or something like that...

I agree.

We lost our compassionate, smart and ethical DON last year. New CEO and DON came in . . . fired CNA's and Ward Clerks.

So, we have 2 RN's on . . . at night the hospital's phone line is directed to our station . .. if both nurses are in rooms, no one can answer the phone. Or call lights. What if someone falls and both nurses are in a room with the door closed for privacy and someone falls in another room? What happens in the morning when the docs round right at the time we pass meds and breakfast trays? Who does the orders? Who sees the stat order? Who watches the monitored patient?

Nope - we need a team.

steph

[EmmaG, RN]

Years ago, I worked with an older NA who was absolutely spectacular. Betty could run circles around us all.

One night, a nurse from SICU agreed to be pulled to our floor to help out. She was fairly new, less than a year out of school and had an annoying holier-than-thou attitude (she worked The Unit)... but I just ignored it and was happy to have the help.

About halfway through the shift, Betty came up to me clearly upset. She had told this nurse that one of her patients was in respiratory distress and asked her to please go re-assess her. This nurse responded by berating her for daring to "assess" a patient, "practicing outside of her scope", etc. Told her that she was the nurse and she didn't need a mere NA telling her how to do her job, and that the NA should get back to the business of taking people to the bathroom and wiping butts.

I swear.

So after the near-code and transfer of the patient to MICU, I pulled this little twit aside. I told her in NO uncertain terms that if I ever heard her speak to an NA like that again, I'd personally see to it that she was disciplined to the extent allowed; and furthermore, Betty had been working that unit since Ms. SICU had been in diapers and had more experience, assessment skills and common sense than she had in her little finger and if Betty said a patient was in trouble then she damned well better check them out.

i.e. I tore her a new one.

I'm not an 'eat our young' kinda of nurse, but I happily chowed down on that one.

[Spidey's mom, ADN, BSN, RN]

:w00t::w00t::w00t:

steph

[MoopleRN]

CNAs need more respect/pay for their extremely demanding job. Of course their scope of practice is different than ours but that makes it no less valuable. I think any nurse who dismisses a NA's request for further assessment is asking for trouble.

And Emmanue Goldstein gave it to her! Good for her!

[jjjoy, LPN]

I think the question is in regard to whether or not nurses prefer to split their patient load with CNAs or not. That's a separate issue from having a unit secretary (to answer calls) or even a floating CNA to assist with call lights, toileting, etc. And it's a separate issue from short-staffing as well. So for the question, let's assume an otherwise well-staffed floor.

In my short clinical experience, I preferred the primary care model. I preferred having fewer patients to be concerned with and being able get a better overall feel of the patient's status because of spending more time with them. Yes, it means more basic nursing care (bed baths, etc) but you can learn so much from those little interactions and they are great opportunities for patient education.

I can see why management would want to not have to pay a RN salary for tasks such as routine toileting & linen changes. I do think CNAs can play an important role in assisting with such functions and in lowering staffing costs, but to have them be surrogate nurses (responsible for reporting vitals, I&Os) leaves the nurse relying on second hand information which can add another level of stress.

Some are seeing the RN role as being more a managerial role... backing up the CNAs & LVNs & making sure their work is done, coordinating patient care (scans, etc), reviewing MD orders for mistakes... if this is indeed the evolving role of the RN then their education should reflect this. My education talked a lot about delegation and managing but the content of instruction was on primary nursing care (and developing care plans the detailed such care). Is the acute care RN a hands-on clinical role where the nurse spends all shift monitoring the patients? Or does the RN spend equal amounts of time also managing their nursing team (CNAs and/or LVNs)? Yes, a good team won't need all that much oversight, but the only way to develop and maintain a good team is through effective oversight & collaboration - so time and effort must be spent on teamwork. Is team leading an integral part of one's nursing role? It seems to be in many facilities and yet team leading is NOT nursing and pulls upon other skills. A great nurse might not be a great team leader. Primary nursing allows the nurse to focus on nursing.

[jessiern, BSN, RN]

Now I lay be down to sleep

Tomorrow I go to work, you see

I wish I may, I wish I might

Have a tech to keep me alive

Amen :wshgrt:

[EmmaG, RN]

CNAs need more respect/pay for their extremely demanding job. Of course their scope of practice is different than ours but that makes it no less valuable. I think any nurse who dismisses a NA's request for further assessment is asking for trouble.

And Emmanue Goldstein gave it to her! Good for her!

Ya know, that happened soooo long ago, but I got angry all over again just typing it out lol.

Arg.